Objectives: To assess the incidence of colonization and infection with carbapenemase producing Enterobacteriaceae (CPE) and carbapenem resistant Acinetobacter baumannii (CR-Ab) in the ICUs of our city hospitals before and during COVID-19 pandemic. Methods: Multicentre before-after cross sectional study to compare the rates of colonization and infection with CPE and/or CR-Ab in two study periods, period 1 (Jan-Apr 2019) and period 2 (Jan-Apr 2020). Incidence rate ratios (IRR) and 95% CI of weekly colonization and infection rates for each period were compared for the two study periods with Poisson regression. Weekly trends in the incidence of colonization or infection for each study period were summarized using local weighted (Loess) regression. Results: There was no significant change in either IRR and weekly trend in CPE colonization and infection during the two study periods. A shift from KPC to other CPE mechanisms (OXA-48 and VIM) was observed during period 2. Compared to period 1, during period 2 the IRR of colonization and infection with CR-Ab increased of 7.5 and 5.5-fold, respectively. Genome sequencing showed that all CR-Ab strains belonged to the CC92/IC2 clonal lineage. Clinical strains clustered closely into a single monophyletic group in one of the three centres, whereas segregated in two different clusters in the other two centres, strongly appoints for the occurrence of horizontal transmission. Conclusion: Our findings remark the need of pursuing infection control activities targeted against the spread of antimicrobial resistance intra and inter hospitals during COVID-19 pandemic, and if necessary re-modulating them according to the new organizational structures imposed by the pandemic.

To evaluate the frequency of myopathy and serum creatine kinase (CK) elevation associated with the use of the integrase inhibitor raltegravir we conducted a retrospective, cohort analysis assessing the incidence of skeletal muscle toxicity among HIV-infected patients treated with raltegravir. Adult HIV-infected patients who started a raltegravir-containing therapy were enrolled into the study. The skeletal muscle toxicity was defined by the presence of one or more of the following parameters: (1) isolated and significant CK elevation without signs or symptoms; (2) diffuse myalgia without weakness; (3) proximal muscle weakness; (4) rhabdomyolysis. On the whole, 155 patients were included in the study, with a mean age of 49.2 years; the median duration of the raltegravir treatment was 30.7 months. The overall frequency of skeletal muscle toxicity was 23.9%, with an incidence of 4.7/100 person-years. An isolated CK elevation was reported in 21.3% of cases, while less than 3% of patients complained of myalgia or muscle weakness. The CK elevation was usually of grade 1 or 2 and self-limiting, and laboratory or clinical abnormalities did not require discontinuation of raltegravir in any patient. Factors significantly associated with skeletal muscle toxicity were previous use of zidovudine, higher baseline CK levels, previous increase of the CK levels, and a higher body mass index. Skeletal muscle toxicity is not an unusual adverse event in subjects receiving raltegravir, but it is usually represented by a mild-to-moderate increase in CK concentration, while clinical symptoms of myopathy are very uncommon.

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A112Eur J Hosp Pharm 2013;20(Suppl 1):A1-A238information was entered into a database (Access) and the adherence to treatment and incidence of adverse events was calculated.Results We analysed the adherence questionnaires of 659 patients, 74% of whom reported 100% adherence to treatment. Coadministered medicines may lead to poorer HAART adherence: patients taking polypharmacy showed medium-low adherence to treatment. Adherence was found to correlate inversely with the daily pill burden. In terms of adverse effects, we developed a pharmacovigilance system, reporting 15 adverse drug reactions, 27% of which were rated severe. We analysed physical changes, gastrointestinal disorders and neuropsychiatric symptoms associated with the following regimens: efavirenz/emtricitabine/tenofovir, emtricitabine/tenofovir + atazanavir/ritonavir, efavirenz/emtricitabine/tenofovir, emtricitabine/tenofovir + atazanavir/ritonavir, emtricitabine/tenofovir + darunavir/ritonavir, abacavir/lamivudine + emtricitabine/tenofovir + darunavir/ritonavir, abacavir/lamivudine + atazanavir/ritonavir, abacavir/lamivudine + darunavir/ritonavir. Our results showed that the regimens with darunavir correlated with a lower incidence of side effects and perception of physical changes. Conclusions The physician-pharmacist collaboration is an important support in monitoring adherence and adverse events related to HAART and contributes significantly to the optimal management of patients with HIV infection.No conflict of interest.Morphine, oxycodone and Fentanyl prescribing patterns in the local health authority oF Messina, italy